Pectus Excavatum

What is pectus excavatum?

Pectus excavatum is the most common chest wall deformity where the sternum (breast bone) and ribs develop abnormally. This causes the sternum to drop inward towards the spine producing a caved in or sunken appearance to the chest. It is sometimes referred to as “funnel” chest. Pectus excavatum is three times more common in boys than girls, is frequently noted within the first year of life, and progresses throughout childhood.

Picture of a severe pectus excavatum.

CT scan showing the sunken in breastbone.

What causes pectus excavatum?

The exact cause of pectus excavatum is not known. It may be a result of imbalanced growth of the sternum and ribs. Recent information suggests there may be a genetic component. It is associated with musculoskeletal disorders such as scoliosis and Marfan’s syndrome which suggests that abnormal connective tissue may play a role. However, the majority of patients with pectus excavatum do not have any musculoskeletal disorders.

What symptoms does pectus excavatum cause?

Many patients do not have any symptoms. Some may experience chest pains, shortness of breath or difficulty in performing athletic activities. In the most severe cases, children state they are not able to keep up with their peers in competitive athletic activity. Some patients report increased stamina or exercise tolerance following surgery.

The most common symptom of pectus excavatum is psychological – many children develop a negative body image and become self-conscious about the appearance of their chest. This may lead them to avoid activities that may draw attention to their chest, such as swimming or changing clothes in the presence of others. In some cases, this may even led to social withdrawal.

How is pectus excavatum evaluated?

First, the child's physician performs a thorough history and physical exam. If surgery is being considered, the child's surgeon may order additional tests or consultations. A CT or CAT scan of the chest is very helpful in measuring the “pectus index” (how severe the pectus exvacatum is). An index greater than 3.25 is generally an indication for surgical repair. Other studies that may be requested before surgery include an electrocardiogram, cardiac echocardiography and lung function studies.

How is pectus excavatum repaired?

There are several surgical options to correct pectus excavatum. The one we offer most commonly is the Minimally Invasive Repair of Pectus Excavatum (MIRPE), also commonly known as the Nuss procedure.

Picture of a Lorenz bar.

Picture of a patient before and after repair of the pectus excavatum.

In this procedure, 2 incisions are made on both sides of the chest, near the arms. A second very small incision is made on the right side of the chest where a camera is inserted to watch the procedure from inside the chest. A metal bar that spans the width of the chest is formed to each patient’s deformity. It is then passed under the breastbone (sternum) with the help of the camera in the chest cavity. The bar lifts up the breastbone and corrects the deformity. Typically, the bar is left in place for 2-3 years.

What is the recovery from the Nuss Procedure like?

Following surgery, most patients spend between 3-5 days in the hospital. Immediately following surgery, breathing exercises and walking is very important. Most patients are able to resume their full activities, including sports and weight lifting by 3 months. Contact sports such as football and hockey and sports that require swinging such as golf may be restricted longer.

What about pain?

While in the hospital, we utilize a special delivery device for administering pain medication called a PCA (patient controlled analgesia). We work very closely with our anesthesiologists and pain service to help manage postoperative pain.

Once you leave the hospital you will receive oral pain medications to take at home.